Provider Demographics
NPI:1851440051
Name:BRUNN, RICHARD W (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:W
Last Name:BRUNN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 SANGER AVE STE 28
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-7805
Mailing Address - Country:US
Mailing Address - Phone:254-772-2043
Mailing Address - Fax:254-772-4671
Practice Address - Street 1:6600 SANGER AVE STE 28
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-7805
Practice Address - Country:US
Practice Address - Phone:254-772-2043
Practice Address - Fax:254-772-4671
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21383103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113704403Medicaid
TXR58817Medicare UPIN
00QH54Medicare ID - Type Unspecified